HESI 1 - V1 and V2 REVIEW - Health
Assessment 1 UPDATED Study Guide
QUESTIONS AND CORRECT ANSWERS
- The nurse is performing a thoracic assessment on a client with
chronic asthma and hyperinflation of the lungs. Which finding should
be expected for this client? - CORRECT ANSWERS Barrel
chest
The nurse is assessing bowel sounds for a hospitalized client. The
nurse has heard bowel sounds in the right upper quadrant. What action
should the nurse take next? - CORRECT ANSWERS Note the
character and frequency of bowel sounds
During inspection of a client's mouth and pharynx, the nurse places a
tongue blade on the back of the tongue which causes the client to gag.
After removing the tongue blade, what action should the nurse take? -
CORRECT ANSWERS Document an intact gag reflex.
When teaching a client how to perform a monthly breast self-
assessment, the nurse should tell the client that it is most important to
assess which part of the breast more closely for changes? -
CORRECT ANSWERS Upper outer quadrant.
The nurse is assessing a postmenopausal client who has a BMI of 32.
The client has a chest measurement of 42 inches, waist measurement
of 45 inches, and hip measurement of 50 inches. What important
message should the nurse explain to the client to promote health
promotion? - CORRECT ANSWERS A waist circumference is
,greater than 35 inches in women puts you at higher risk for type 2
diabetes and heart disease."
The nurse performs a physical assessment on an older female client.
Which change from the prior exam may be an indication of
osteoporosis? - CORRECT ANSWERS Height reduction of
1.5 inches.
While conducting an interview to obtain a health history, the nurse
notices that the client pauses frequently and looks at the nurse
expectantly. Which response is best for the nurse to provide? -
CORRECT ANSWERS Sit quietly to allow the client to
respond comfortably.
A client is in the clinical for a yearly physical examination. Which
action should the nurse take when preparing to examine the client's
abdomen? - CORRECT ANSWERS Ask the client to urinate
before beginning the examination.
Which respiratory condition should the nurse document after
measuring a respiratory rate of 8 breaths/minute? - CORRECT
ANSWERS Bradypnea.
Which procedure should the nurse use to assessfor a pulse deficit? -
CORRECT ANSWERS Measure the apical pulse and compare
it to the peripheral pulse.
, *A pulse deficit is a palpable difference between the apical pulse at
the point of maximal impulse and the radial pulse palpated at the
wrist.
A client has been diagnosed with bilateral lower lobe atelectasis.
What percussion sound should the nurse expect to hear when
percussing over the client's lower lobes? - CORRECT ANSWERS
Dull, thud-like.
A client is being assessed upon admission to the medical-surgical unit.
The nurse is preparing to complete a head-to-toe assessment and will
begin at the head of the client. Which technique should the nurse use
to begin the assessment? - CORRECT ANSWERS Inspect the
hair and skin.
The nurse is assessing a healthy young adult during an annual
physical examination. Which assessment technique should the nurse
implement when palpating the abdominal aorta? - CORRECT
ANSWERS Deep palpation above and to the left of the
umbilicus.
The nurse is conducting a family history as part of the assessment
interview. Which action should the nurse take to ensure that sufficient
information about the client's blood relatives is obtained? -
CORRECT ANSWERS Document at least 3 generations of the
client's family medical history.
The nurse is testing the client's shoulders for range of motion. What
should the nurse document to record normal internal rotation? -
Assessment 1 UPDATED Study Guide
QUESTIONS AND CORRECT ANSWERS
- The nurse is performing a thoracic assessment on a client with
chronic asthma and hyperinflation of the lungs. Which finding should
be expected for this client? - CORRECT ANSWERS Barrel
chest
The nurse is assessing bowel sounds for a hospitalized client. The
nurse has heard bowel sounds in the right upper quadrant. What action
should the nurse take next? - CORRECT ANSWERS Note the
character and frequency of bowel sounds
During inspection of a client's mouth and pharynx, the nurse places a
tongue blade on the back of the tongue which causes the client to gag.
After removing the tongue blade, what action should the nurse take? -
CORRECT ANSWERS Document an intact gag reflex.
When teaching a client how to perform a monthly breast self-
assessment, the nurse should tell the client that it is most important to
assess which part of the breast more closely for changes? -
CORRECT ANSWERS Upper outer quadrant.
The nurse is assessing a postmenopausal client who has a BMI of 32.
The client has a chest measurement of 42 inches, waist measurement
of 45 inches, and hip measurement of 50 inches. What important
message should the nurse explain to the client to promote health
promotion? - CORRECT ANSWERS A waist circumference is
,greater than 35 inches in women puts you at higher risk for type 2
diabetes and heart disease."
The nurse performs a physical assessment on an older female client.
Which change from the prior exam may be an indication of
osteoporosis? - CORRECT ANSWERS Height reduction of
1.5 inches.
While conducting an interview to obtain a health history, the nurse
notices that the client pauses frequently and looks at the nurse
expectantly. Which response is best for the nurse to provide? -
CORRECT ANSWERS Sit quietly to allow the client to
respond comfortably.
A client is in the clinical for a yearly physical examination. Which
action should the nurse take when preparing to examine the client's
abdomen? - CORRECT ANSWERS Ask the client to urinate
before beginning the examination.
Which respiratory condition should the nurse document after
measuring a respiratory rate of 8 breaths/minute? - CORRECT
ANSWERS Bradypnea.
Which procedure should the nurse use to assessfor a pulse deficit? -
CORRECT ANSWERS Measure the apical pulse and compare
it to the peripheral pulse.
, *A pulse deficit is a palpable difference between the apical pulse at
the point of maximal impulse and the radial pulse palpated at the
wrist.
A client has been diagnosed with bilateral lower lobe atelectasis.
What percussion sound should the nurse expect to hear when
percussing over the client's lower lobes? - CORRECT ANSWERS
Dull, thud-like.
A client is being assessed upon admission to the medical-surgical unit.
The nurse is preparing to complete a head-to-toe assessment and will
begin at the head of the client. Which technique should the nurse use
to begin the assessment? - CORRECT ANSWERS Inspect the
hair and skin.
The nurse is assessing a healthy young adult during an annual
physical examination. Which assessment technique should the nurse
implement when palpating the abdominal aorta? - CORRECT
ANSWERS Deep palpation above and to the left of the
umbilicus.
The nurse is conducting a family history as part of the assessment
interview. Which action should the nurse take to ensure that sufficient
information about the client's blood relatives is obtained? -
CORRECT ANSWERS Document at least 3 generations of the
client's family medical history.
The nurse is testing the client's shoulders for range of motion. What
should the nurse document to record normal internal rotation? -
